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General NPI Number Information
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NPI Number | 1306091574
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Entity Type | Organization
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Legal Business Name | MICHAEL L. RECKER, O.D. LLC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 410 LOUISIANA AVE
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City | PERRYSBURG
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State | OH
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Zip | 43551-2269
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Country | US
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Telephone | 419-872-2020
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Fax | 419-872-2029
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Provider Business Mailing Address
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Address Line | 410 LOUISIANA AVE
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City | PERRYSBURG
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State | OH
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Zip | 43551-2269
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Country | US
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Telephone | 419-872-2020
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Fax | 419-872-2029
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. JODI M. RECKER
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Credential |
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Telephone | 419-872-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 4870
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4870
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License Number State | OH
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